title: Proximal vertebral body fracture after 4-level fusion using l1 as the upper instrumented vertebra for lumbar degenerative disease: report of 2 cases with literature review.
abstract: Some cases with lumbar degenerative diseases require multi-level fusion surgeries. At our institute, 27 and 4 procedures of 3- and 4-level fusion were performed out of a total 672 posterior lumbar interfusions (PLIFs) on patients with lumbar degenerative disease from 2005 to 2010. We present 2 osteoporotic patients who developed proximal vertebral body fracture after 4-level fusion. Both cases presented with gait disability for leg pain by degenerative lumbar scoliosis and canal stenosis at the levels of L1/2-4/5. After 4-level fusion using L1 as the upper instrumented vertebra, proximal vertebral body fractures were found along with the right pedicle fractures of L1 in both cases. One of these patients, aged 82 years, was treated as an outpatient using a hard corset for 24 months, but the fractures were exacerbated over time. In the other patient, posterolateral fusion was extended from Th10 to L5. Both patients can walk alone and have been thoroughly followed up. In both cases, the fracture of the right L1 pedicle might be related to the subsequent fractures and fusion failure. In consideration of multi-level fusion, L1 should be avoided as an upper instrumented vertebra to prevent junctional kyphosis, especially in cases with osteoporosis and flat back posture.
authors.affiliation: Department of Spinal Surgery, Shinkomonji Hospital, Kitakyushu, Fukuoka 800-0057, Japan. tyasu37@cc.okayama-u.ac.jp
authors.forename: Takao
authors.initials: T
authors.lastname: Yasuhara
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Takahashi
authors.forename: Shinji
authors.initials: S
authors.lastname: Kumamoto
authors.forename: Masayuki
authors.initials: M
authors.lastname: Nakahara
authors.forename: Kotaro
authors.initials: K
authors.lastname: Yoneda
authors.forename: Tatsuomi
authors.initials: T
authors.lastname: Niimura
authors.forename: Takashi
authors.initials: T
authors.lastname: Tanoue
authors.forename: Akira
authors.initials: A
authors.lastname: Kusumegi
authors.forename: Takashi
authors.initials: T
authors.lastname: Sennari
authors.forename: Yasukazu
authors.initials: Y
authors.lastname: Hijikata
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Manabe
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Miyoshi
authors.forename: Isao
authors.initials: I
authors.lastname: Date
authors.forename: Koichi
authors.initials: K
authors.lastname: Ogawa
authors.forename: Kenki
authors.initials: K
authors.lastname: Nishida
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging* / Q000293:injuries / Q000601:surgery; D008297:Male; D010024:Osteoporosis / Q000000981:diagnostic imaging / Q000601:surgery; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000209:etiology*; D011859:Radiography; D012600:Scoliosis / Q000000981:diagnostic imaging / Q000601:surgery; D016103:Spinal Fractures / Q000000981:diagnostic imaging / Q000209:etiology*; D013123:Spinal Fusion / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods